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Grading and Staging Chronic Hepatitis in Liver Biopsy

Purpose: To grade the severity of involvement and stage the degree of fibrosis in chronic hepatitis.

Description

The terminology used to describe the histopathology of chronic hepatitis has been recently updated. Terms used previously such as chronic persistent hepatitis, chronic active hepatitis and chronic lobular hepatitis have been discontinued in favor of a schema give a grade of inflammatory activity and stage of fibrosis.


 

Grading of Inflammatory Activity

Grade

Portal Inflammation

Lobular Inflammation

0

none or minimal

none

1

portal inflammation

inflammation but no necrosis

2

mild limiting plate (piecemeal) necrosis with mild periportal inflammation

mild inflammation with focal necrosis or acidophilic bodies

3

moderate limiting plate (piecemeal) necrosis

moderate inflammation with severe focal damage

4

severe limiting plate (piecemeal) necrosis

severe diffuse hepatocellular damage with bridging necrosis

 

 

Staging the Degree of Fibrosis

 

Stage

Fibrosis

0

no fibrosis (normal connective tissue)

1

fibrosis confined to enlarged portal tracts

2

periportal fibrosis, or rare portal-to-portal fibrous septa but intact lobular architecture

3

septal fibrosis with architectural distortion but no obvious cirrhosis (regenerative nodules, etc.)

4

cirrhosis

 

 


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Specialty

Objective

ICD-10